Provider Demographics
NPI:1578348298
Name:PRECIADO, TESSA D
Entity Type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:D
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-0788
Mailing Address - Country:US
Mailing Address - Phone:505-867-3396
Mailing Address - Fax:
Practice Address - Street 1:412 CAMINO DON TOMAS
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-9101
Practice Address - Country:US
Practice Address - Phone:150-548-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician